Background The surgery treatment strategies for elderly patients who were diagnosed as choledocholithiasis combined with cholecystolithiasis include laparoscopic choledocholithotomy with cholecystectomy and T-tube drainage or endoscopic sphincterotomy with nasobiliary drainage alone for those selected elderly patients without symptoms related to the gallbladder. However, long-term T-tube drainage will cause pain and life inconvenient. This study was designed to retrospective analysis the primary suture of the common bile duct and the T-tube drainage after laparoscopic choledochotomy to study the merits and demerits between primary suture and T-tube drainage in elderly patients. Methods Eighty-five patients were screened from January 2017 to January 2018. All patients were performed laparoscopic surgery, and an intraperitoneal drainage tube was left in all patients. Fifty-six cases were the primary suture group (n=56). Twenty-nine cases were the T-tube group (n=29). Preoperative baseline characteristics, intraoperative and postoperative characteristics of the two groups were compared. Results There were no differences in baseline characteristics in both groups (P＞0.05). Compared with the T-tube group, the postoperative total drainage volume on the first day [15(15, 58.75) vs 292(185, 360)] and patients of residual stones (0/56 vs 5/29) were fewer, and all drainage tube indwelling time [6(5,7) vs 84(82,86.5)] was shorter in the primary suture group(P﹤0.05). And there were statistically significant differences in postoperative total drainage volume on the first day [15(15, 58.75) vs 292(185, 360)], all drainage tube indwelling time [6(5, 7) vs 84(82, 86.5)], postoperative total bilirubin [22.15(13.475, 33) vs 31.3(20.6,57.3)] and residual stones (0/56 vs 5/29) between the two groups (P<0.05). There were no statistically significant differences in the other intraoperative and postoperative characteristics(P＞0.05). There were no pressure sores, postoperative pneumonia, deep vein thrombosis, serious complications of heart, lung and brain and even death in both groups. Conclusions With accurate preoperative risk assessment and strict treatment of basic diseases for elderly patients, if the stones in the common bile duct were cleared in laparoscopic surgery, the primary suture in elderly patients is feasible, safe, and valid.